Morning RoundsCivility is more than politeness -- it means showing respect

October 18, 2016 at 8:40 am

I believe the bulk of humanity works hard to be kind and genuine. It can be a struggle, but most of us try to be the best people we can be.

That is not only a belief; it is also a personal choice. Believing the best in people makes it easier to trust, to communicate and when mistakes happen, to forgive and move on. A lack of communication, trust, and forgiveness makes doing even the simplest things incredibly hard.

That’s why the level of political discourse in this country is so disheartening. Without civility, communication shuts down, people assume the worst of each other, small problems become big problems, and big problems escalate.

A few years ago, three young men who were all highly intoxicated were brought by ambulance to the Maine Medical Center emergency department. They all showed the same general symptoms: confusion, impaired judgment, slurred speech, and difficulty with balance. Those symptoms are not unusual on any given weekend night. Of more concern was the fact that while they all admitted to using alcohol, it seemed that they had also taken some other drug. Because they wouldn’t cop to it, we didn’t know whether they had used marijuana, mushrooms, or a host of other newer synthetic drugs that can cause confusion and agitation.

Standard practice in cases like this is to do an initial evaluation to make certain they are in no immediate danger, and then give the toxins a chance to work their way out of the patients’ systems. Over time, we regularly examine them to follow their progress and make sure they are still safe.

It was a busy night but the emergency-medicine resident, who is a compassionate and capable doctor, checked back in with the three young men as often as he could. When one does this type of evaluation, one is looking for several things. Since they are usually asleep, one of the first things one notices is how quickly they wake up, and how long it takes them to orient themselves.

Some people are not easy to wake up, so we may have to use painful stimuli, rubbing on their chest bone with a knuckle, pushing on a fingernail, or using smelling salts.

Once they wake up, they usually need to go to the bathroom, which allows us to monitor how well they walk. The ultimate test is if they are “oriented times three,” which means they know who they are, where they are, and the date. And they need to be able to walk safely.

Finally, they need to have a plan — hopefully a plan to get home with someone who can keep an eye on them. When they can tell us where they live and how they are going to get there, they are usually ready to leave.

By first light that morning, two of the patients had gone home.

The third young man still seemed somewhat impaired. He could walk to the bathroom, but his gait was unsteady, and he could talk, but his speech was slurred.

Finally, he asked my resident why his friends had gone home but he hadn’t. The resident said he couldn’t go home because he was still intoxicated. The young man, clearly frustrated, said he wasn’t.

My resident laid it out straight. He said, “You are unsteady on your feet and you are still slurring your words.” The young man looked right back at him and said: “I have cerebral palsy.”

Cerebral palsy is a condition caused by damage to parts of the brain that control movement, usually during pregnancy or at birth. The symptoms can be similar to some of those exhibited by the three young men when they arrived.

The resident immediately and very genuinely apologized. Although he was not happy with the mistake, our patient accepted the apology and called his parents. They confirmed he was their son and was acting normally and took him home.

That misdiagnosis could have resulted in a lot of hurt feelings or even a lawsuit, but fortunately the patient was gracious and understanding.

My younger sister had cerebral palsy and I have been with her when people were not at all sensitive to her condition. When that was due to a misunderstanding and was followed quickly by an apology, it was easy to move on. When somebody was rude and didn’t care enough to apologize, it could be extremely hard to forgive.

In the case of our resident, it was the context of the situation that was misleading. The apology worked because our patient knew that the resident had his best interests at heart and because he could tell he felt terrible.

In an emergency department, teams have to work together to solve complicated problems quickly. If there isn’t an atmosphere of mutual respect in which people can speak freely, those teams don’t work well together and patients die as a result.

Our country is facing problems vastly more complex than the average medical emergency. If the whole point of winning a political contest is the chance to help solve those problems, the level of political discourse now on display only guarantees that, regardless of outcome, we all lose in the end.